Doctors Sue Over ER Limits in Washington State

The state now limits non-emergency ER visits for Medicaid patients.

October 1, 2011, 4:34 PM

Oct. 1, 2011 — -- The American College of Emergency Physicians is suing the state of Washington in an effort to overturn the decision that low-income Medicaid patients will be limited to three non-emergency visits to the emergency room each year, which goes into effect today.

The suit seeks to get rid of the limit, which it says puts patients at risk.

The limit, which was created to reduce costs in emergency rooms, comes with a new list of 700 non-emergency symptoms, including difficulty breathing, dizziness, early-pregnancy hemorrhage, gall stones, abdominal pains and chest pains not related to a heart attack.

Patients with any of the 700 symptoms are urged to visit the regular doctor's office instead of the emergency room.

But doctors say patients may not be able to tell if their symptoms are indicative of an emergency.

For example, if a child burns himself on the stove, a parent may not know the difference between first, second and third degree burns.

"The ACEP is opposing the limit primarily because of the list of diagnoses that the state is proposing to be non-emergencies, like chest pains and heart arrhythmias and dysrhythmias, which can result in sudden death, sudden blindness, and hemorrhages during miscarriage," ACEP Washington Chapter president Steve Anderson said. "Their proposal is dangerous. It's almost funny it's so scary they would have them on the list.

"I don't want people to sit at home and self diagnose. People should seek care early for true emergencies -- that's what the ER is for. We're open 24/7, 365 days a year, so if your chest pains started at 10 p.m., you shouldn't wait until the next morning to call your primary care doctor," he said.

Sexually transmitted diseases are also included on the list of non-emergencies.

"A lot of people don't want to go to their family doctor with these issues," Anderson said.

The limit, which will cut $72 million in state and federal funds, is included in the 2011-13 Washington State budget.

"We want to save the state money. We want to work with the state," Anderson said. "But they were given a number to reach for the budget, and the only way to do so was to add diagnoses to the list that they originally decided were unquestionably emergencies. That's where we have to draw the line."

The Washington State Hospital Association (WSHA), the Washington State Medical Association (WSMA), and the Washington Chapter of the Academy of Emergency Physicians (WCAEP) have also released statements saying they object to the change.

"We share the state's goal of reducing preventable emergency room visits. However, this benefit limit is not a reasonable approach to the problem," read a statement on the WSHA website.

"[The list] contains many emergency conditions such as chest pain, women having miscarriages, and children who are ill and in pain," the statement read. "In addition, the list creates a public health concern as patients who have sexually transmitted diseases are being asked to wait until they can get a primary care office visit."

If a Medicaid patient comes in for a fourth emergency room visit with non-emergency symptoms, he or she will be treated, but the state won't pay the hospital. Instead, the hospital will have to pay for it.

"There is a national legislation called the Prudent Lay Person Law, which says that your average Joe, if he has what he thinks is an emergency, is entitled to go to the ER, be evaluated and treated for it, and his insurance company can't retrospectively deny it," Anderson said. "That's in place to protect everybody. Not just Medicaid patients -- everybody. Our concern is that the health care authority said that doesn't apply to our clients. We're terrified that other places in the country will feel that it doesn't apply to their clients and constituents as well."

The Healthcare Authority of Washington has been in contact with 15 other states regarding the emergency room limit. If the limit works in Washington, these other states are considering implementing it.

Calls made by ABC News to Washington State officials were not immediately returned, and there are no press releases or news statements pertaining to the issue on the state website.

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